THE MANAGEMENT OF NAUSEA AND VOMITING OF PREGNANCY AND HYPEREMESIS GRAVIDARUM- A 2013 UPDATE
Main Article Content
Keywords
Nausea, vomiting, pregnancy, hyperemesis gravidarum, antiemetics
Abstract
Nausea and vomiting of pregnancy (NVP) affects up to 85% of all pregnancies, yet many physicians are uncertain as to how to best treat their patients in the presence of controversial data on fetal risks. This review provides an update on the management of NVP, including pharmacological and non pharmacological approaches. Due to a high rate of recurrent symptoms, it is important for women to receive early treatment to reduce the severity of symptoms with the aim of preventing the need for hospitalization and improving quality of life.
References
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3. ACOG (American College of Obstetrics and Gynecology). Practice bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004;103(4):803-814.
4. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Practice 1993;43:245–248.
5. Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician 2007;53(12):2109-11.
6. Magee LA, Chandra K, Mazzotta P, Stewart D, Koren G, Guyatt GH. Development of a health-related quality of life instrument for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002; 186(5):S232- S238.
7. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynecol 2000;21(3):129–136.
8. Smith C, Crowther C, Beilby J, Dandead J. The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 2000;40(4):397-401.
9. O’Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women’s lives. Birth 1992;19:138–143.
10. Piwko C, Ungar WJ, Einarson TR, Wolpin J, Koren G. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007; 23(4): 833-40.
11. Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin N Am 2008;35:401-417.
12. Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol 2007;21(5):755-69.
13. Bottomley C, Bourne T. Management strategies for hyperemesis. Best Pract Res Clin Obstet Gynaecol 2009; 23(4):549-64.
14. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11(5):527-39.
15. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006;107(2 Pt 1):277-84.
16. Mazzotta P, Magee L, Koren G. Therapeutic abortions due to severe morning sickness-Motherisk Update. Can Fam Phys 1997;43:1055–1057.
17. Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. Journal of Perinatol 2010;1–11.
18. Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, Goodwin TM. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 2009;18(12):1981–1987.
19. Bailit J. Hyperemesis gravidarum: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005;193:811-4.
20. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obstet Gynaecol 2004;24(5):530-3.
21. Koch KL, Frissora CL. Nausea and vomiting during pregnancy. Gastroenterol Clin North Am 2003;32(1):201-34.
22. Sherman PW, Flaxman SM. Nausea and vomiting of pregnancy in an evolutionary perspective. Am J Obstet Gynecol 2002;186(5 Suppl), S190-7.
23. Veenendaal M, van Abeelen A, Painter R, van der Post J, Roseboom T. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011; doi: 10.1111/ j.1471-0528.2011.03023.x. [Epub ahead of print].
24. American Gastroenterological Association. (2001). AGA Technical Review on Nausea and Vomiting. Gastroenterology 2001;120: 263-286.
25. Nguyen P, Einarson A. Managing nausea and vomiting of pregnancy with pharmacological and non-pharmacological treatments. Women’s Health 2006;2(5):753-760.
26. Jednak MA, Shadigian EM, Kim MS, Woods ML, Hooper FG, Owyang C, Hasler WL. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol 1999;277(4 Pt 1): G855–861.
27. Erick M. Battling morning (noon and night) sickness. J Am Diet Assoc 1994;94:147–148.
28. Gill SK, Maltepe C, Mastali K, Koren G. The effect of acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009;585269:1-4.
29. Gill SK, O'Brien L, Koren G. (2009). The safety of histamine 2 (H2) blockers in pregnancy: a meta-analysis. Dig Dis Sci 2009;54(9):1835-8.
30. Gill SK, O'Brien L, Einarson TR, Koren G. The safety of proton pump inhibitors (PPIs) in pregnancy: a meta-analysis. Am J Gastroenterol 2009;104(6):1541-5.
31. Pasternak B, Hviid A. Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. N Engl J Med 2010;363:2114-23.
32. Sandven I, Abdelnoor M, Nesheim B, Melby KK. Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of case-control studies. Acta Obstet Gynecol Scand 2009;88(11):1190–1200.
33. Guven MA, Ertas IE, Coskun A, Ciragil P. Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: which test is useful during early pregnancy? Taiwan J Obstet Gynecol 2011;50(1):37-41.
34. Shrim R, Boskovic C, Maltepe C, Navios Y, Garcia-Bournissen F, Koren G. Pregnancy outcome following use of large doses of vitamin B6 in the first trimester. J Obstet Gynaecol 2006; 26(8): 749–751.
35. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea and vomiting. J Altern Complement Med 2009;15(3):243-246.
36. Roscoe JA. Matteson SE. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol 2002;186:S244–7.
37. Mccormack D. Hypnosis for hyperemesis gravidarum. J Obstet Gynaecol 2010;30(7):647-53.
38. Lub-Moss MM, Eurelings-Bontekoe EH. Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models. Patient Educ Couns 1997;31:65–75.
39. Köken G, Yilmazer M, Cosar E, Sahin FK, Cevrioglu S, Gecici O. Nausea and vomiting in early pregnancy: relationship with anxiety and depression. J Psychosom Obstet Gynaecol 2008; 29(2): 91-5.
40. Arsenault MY, Lane CA, MacKinnon CJ, Bartellas E, Cargill YM, Klein MC, Martel MJ, Sprague AE, Wilson AK. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Canada 2002;24(10):817–833.
41. Brent R. Bendectin and Birth Defects: Hopefully, the Final Chapter. Birth Defects Research 2003; (Part A) 67:79-87.
42. Lamm SH. (2000). The epidemiological assessment of the safety and efficacy of Bendectin. In “Nausea and Vomiting of Pregnancy: State of the Art 2000” (Koren G and Bishai R, eds), Vol. I, pp. 100–103. Motherisk, Toronto
43. Nulman I, Rovet J, Barrera M, Knittel-Keren D, Feldman BM, Koren G. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr 2009;155:45-50.
44. Koren G, Clark S, Hankins GD, Caritis SN, Miodovnik M, Umans JG, Mattison D. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol 2010 Dec;203(6):571.e1-7.
45. Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007;6(6): 685–694.
46. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781–800.
47. Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009;60(24):2528-2535.
48. Choi JS, Han JY, Ahn HK, Lee SW, Kim MH, Chung JH, Ryu HM, Kim MY, Yang JH, Choi KH, Navaocampo AA, Koren G. Fetal outcome after exposure to domperidone during early pregnancy. Birth Defects Research Part A: Clinical and Molecular Teratology. Conference: Teratology Society 49th Annual Meeting Rio Grande Puerto Rico. Conference Publication 2009;85(5):496.
49. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG 2004;111:940–943.
50. Turcotte V, Ferreira E, Duperron L. Utilite de droperidol et de la diphenhydramine dans l'hyperemesis gravidarum. J Soc Obstet Gynaecol Can 2001;23:133-9.
51. Ferreira E, Bussieres JF, Turcotte V, Duperron L, Ouellet. Case-control study comparing droperidol plus diphenhydramine in hyperemesis gravidarum. J Pharm Technol 2003;19:349-354.
52. Milkovich L, Van den Berg BJ. An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 1976;125:244-8.
53. Heinonen OP, Slone D, Shapiro S. (1977). Birth Defects and Drugs in Pregnancy. pp. 323-324, 327, 330, 437, 489. Publishing Sciences Group. Littleton, Mass.
54. Jick H, Holmes LB, Hunter JR, Madsen S, Stergachis A. First-trimester drug use and congenital disorders. JAMA 1981;246(4):343-346.
55. Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinat 1997;14:119–124.
56. Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000;62(6):385-92.
57. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ. National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007; 197(6):585.e1-7.
58. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy A. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol 2004;18:93–101.
59. Hamaoui E, Hamaoui M. Nutritional assessment and support during pregnancy. Gastroenterol Clin N Am 2003;32:59–121.
60. Lamondy A. Managing hyperemesis gravidarum. Nursing 2007;37(2):66-68.
61. Lamondy A. Hyperemesis gravidarum and the role of the infusion nurse. J Infus Nurs 2006;29(2):89-100.
2. Jewell D, Young G. (2003). Interventions for nausea and vomiting in early pregnancy. The Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD000145.
3. ACOG (American College of Obstetrics and Gynecology). Practice bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004;103(4):803-814.
4. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Practice 1993;43:245–248.
5. Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician 2007;53(12):2109-11.
6. Magee LA, Chandra K, Mazzotta P, Stewart D, Koren G, Guyatt GH. Development of a health-related quality of life instrument for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002; 186(5):S232- S238.
7. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynecol 2000;21(3):129–136.
8. Smith C, Crowther C, Beilby J, Dandead J. The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 2000;40(4):397-401.
9. O’Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women’s lives. Birth 1992;19:138–143.
10. Piwko C, Ungar WJ, Einarson TR, Wolpin J, Koren G. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007; 23(4): 833-40.
11. Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin N Am 2008;35:401-417.
12. Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol 2007;21(5):755-69.
13. Bottomley C, Bourne T. Management strategies for hyperemesis. Best Pract Res Clin Obstet Gynaecol 2009; 23(4):549-64.
14. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11(5):527-39.
15. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006;107(2 Pt 1):277-84.
16. Mazzotta P, Magee L, Koren G. Therapeutic abortions due to severe morning sickness-Motherisk Update. Can Fam Phys 1997;43:1055–1057.
17. Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. Journal of Perinatol 2010;1–11.
18. Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, Goodwin TM. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 2009;18(12):1981–1987.
19. Bailit J. Hyperemesis gravidarum: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005;193:811-4.
20. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obstet Gynaecol 2004;24(5):530-3.
21. Koch KL, Frissora CL. Nausea and vomiting during pregnancy. Gastroenterol Clin North Am 2003;32(1):201-34.
22. Sherman PW, Flaxman SM. Nausea and vomiting of pregnancy in an evolutionary perspective. Am J Obstet Gynecol 2002;186(5 Suppl), S190-7.
23. Veenendaal M, van Abeelen A, Painter R, van der Post J, Roseboom T. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011; doi: 10.1111/ j.1471-0528.2011.03023.x. [Epub ahead of print].
24. American Gastroenterological Association. (2001). AGA Technical Review on Nausea and Vomiting. Gastroenterology 2001;120: 263-286.
25. Nguyen P, Einarson A. Managing nausea and vomiting of pregnancy with pharmacological and non-pharmacological treatments. Women’s Health 2006;2(5):753-760.
26. Jednak MA, Shadigian EM, Kim MS, Woods ML, Hooper FG, Owyang C, Hasler WL. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol 1999;277(4 Pt 1): G855–861.
27. Erick M. Battling morning (noon and night) sickness. J Am Diet Assoc 1994;94:147–148.
28. Gill SK, Maltepe C, Mastali K, Koren G. The effect of acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009;585269:1-4.
29. Gill SK, O'Brien L, Koren G. (2009). The safety of histamine 2 (H2) blockers in pregnancy: a meta-analysis. Dig Dis Sci 2009;54(9):1835-8.
30. Gill SK, O'Brien L, Einarson TR, Koren G. The safety of proton pump inhibitors (PPIs) in pregnancy: a meta-analysis. Am J Gastroenterol 2009;104(6):1541-5.
31. Pasternak B, Hviid A. Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. N Engl J Med 2010;363:2114-23.
32. Sandven I, Abdelnoor M, Nesheim B, Melby KK. Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of case-control studies. Acta Obstet Gynecol Scand 2009;88(11):1190–1200.
33. Guven MA, Ertas IE, Coskun A, Ciragil P. Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: which test is useful during early pregnancy? Taiwan J Obstet Gynecol 2011;50(1):37-41.
34. Shrim R, Boskovic C, Maltepe C, Navios Y, Garcia-Bournissen F, Koren G. Pregnancy outcome following use of large doses of vitamin B6 in the first trimester. J Obstet Gynaecol 2006; 26(8): 749–751.
35. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea and vomiting. J Altern Complement Med 2009;15(3):243-246.
36. Roscoe JA. Matteson SE. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol 2002;186:S244–7.
37. Mccormack D. Hypnosis for hyperemesis gravidarum. J Obstet Gynaecol 2010;30(7):647-53.
38. Lub-Moss MM, Eurelings-Bontekoe EH. Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models. Patient Educ Couns 1997;31:65–75.
39. Köken G, Yilmazer M, Cosar E, Sahin FK, Cevrioglu S, Gecici O. Nausea and vomiting in early pregnancy: relationship with anxiety and depression. J Psychosom Obstet Gynaecol 2008; 29(2): 91-5.
40. Arsenault MY, Lane CA, MacKinnon CJ, Bartellas E, Cargill YM, Klein MC, Martel MJ, Sprague AE, Wilson AK. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Canada 2002;24(10):817–833.
41. Brent R. Bendectin and Birth Defects: Hopefully, the Final Chapter. Birth Defects Research 2003; (Part A) 67:79-87.
42. Lamm SH. (2000). The epidemiological assessment of the safety and efficacy of Bendectin. In “Nausea and Vomiting of Pregnancy: State of the Art 2000” (Koren G and Bishai R, eds), Vol. I, pp. 100–103. Motherisk, Toronto
43. Nulman I, Rovet J, Barrera M, Knittel-Keren D, Feldman BM, Koren G. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr 2009;155:45-50.
44. Koren G, Clark S, Hankins GD, Caritis SN, Miodovnik M, Umans JG, Mattison D. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol 2010 Dec;203(6):571.e1-7.
45. Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007;6(6): 685–694.
46. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781–800.
47. Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009;60(24):2528-2535.
48. Choi JS, Han JY, Ahn HK, Lee SW, Kim MH, Chung JH, Ryu HM, Kim MY, Yang JH, Choi KH, Navaocampo AA, Koren G. Fetal outcome after exposure to domperidone during early pregnancy. Birth Defects Research Part A: Clinical and Molecular Teratology. Conference: Teratology Society 49th Annual Meeting Rio Grande Puerto Rico. Conference Publication 2009;85(5):496.
49. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG 2004;111:940–943.
50. Turcotte V, Ferreira E, Duperron L. Utilite de droperidol et de la diphenhydramine dans l'hyperemesis gravidarum. J Soc Obstet Gynaecol Can 2001;23:133-9.
51. Ferreira E, Bussieres JF, Turcotte V, Duperron L, Ouellet. Case-control study comparing droperidol plus diphenhydramine in hyperemesis gravidarum. J Pharm Technol 2003;19:349-354.
52. Milkovich L, Van den Berg BJ. An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 1976;125:244-8.
53. Heinonen OP, Slone D, Shapiro S. (1977). Birth Defects and Drugs in Pregnancy. pp. 323-324, 327, 330, 437, 489. Publishing Sciences Group. Littleton, Mass.
54. Jick H, Holmes LB, Hunter JR, Madsen S, Stergachis A. First-trimester drug use and congenital disorders. JAMA 1981;246(4):343-346.
55. Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinat 1997;14:119–124.
56. Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000;62(6):385-92.
57. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ. National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007; 197(6):585.e1-7.
58. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy A. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol 2004;18:93–101.
59. Hamaoui E, Hamaoui M. Nutritional assessment and support during pregnancy. Gastroenterol Clin N Am 2003;32:59–121.
60. Lamondy A. Managing hyperemesis gravidarum. Nursing 2007;37(2):66-68.
61. Lamondy A. Hyperemesis gravidarum and the role of the infusion nurse. J Infus Nurs 2006;29(2):89-100.